Spinal cord injury rehabilitation model G. Zeilig, MD, Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer.

Spinal cord injury rehabilitation model

G. Zeilig, MD, Department of Neurological Rehabilitation,Sheba Medical Center, Tel Hashomer

Meeting the needs (the 3 “P’s”)

Patient

Provider

Payor

Quality of care

Cost containment

Quality of life

The patient

WHAT’S A SPINAL CORD INJURY?

•Loss of motor and sensory function bellow the level of injury•Spasticity•Pain•Sexual dysfunction•Loss of bowel & bladder control

International Standards for Neurological Classification of Spinal Cord Injury

ASIA (American Spinal Injury Association) Neurological level of injury (NLOI) Completeness of the injury (ASIA

impairment classification)

72 hour exam - reliable prognostic time

ASIA

American Spinal Injury Association (ASIA )

Classification

SCI = multi-systems failure

RESPIRATORYRESPIRATORY

NERVOUSNERVOUS

ENDOCRINEENDOCRINE

IMMUNEIMMUNE

GASTO-INTESTINALGASTO-INTESTINAL

GENITO-URINARYGENITO-URINARY

CARDIO-VASCULARCARDIO-VASCULAR

METABOLICMETABOLIC

MUSCULO-SKELETALMUSCULO-SKELETAL

PSYCHIATRICPSYCHIATRIC

SKINSKIN

REPRODUCTIVEREPRODUCTIVE

SCI – related medical conditions

Spinal shock Spinal cord syndromes Autonomic dysreflexia Neuropathic pain Spasticity Heterotopic ossification Syrinx Gynecomastia

SCI = multi-functions failure

B-ADL E-ADL Mobility AmbulationSocio – economic

International Classification of Functioning, Disability and

Health (ICF)

Living with SCI

Living with SCI

Acute restoration phase

Maintenance phase

Decline phase

Conflicting goalsQuality of life

Independence

Preservation of function

Long-term survivalDiminished life expectancy (?)

Life expectancy has been improving

SPINAL CORD INJURY:Statistics

SPINAL CORD INJURY:Numbers

> 10.000 SCI/year

30-50/1.000.000 new SCI/year

200.000 living SCI in USA

Annual cost : $ 5 billion

Most frequent SCI

TetraplegiaComplete

(%)

TetraplegiaIncomplete

(%)

ParaplegiaComplete

(%)

ParaplegiaIncomplete

(%)

17.531.228.223.1

Average Yearly Expenses

(in 2005 dollars)

Severity of InjuryFirst Year

Each Subsequent Year

High Tetraplegia (C1-C4)$710,275$127,227

Low Tetraplegia (C5-C8)$458,666$52,114

Paraplegia$259,531$26,410

Incomplete motor at any level$209,324$14,670

The Cook Dietician Nurse Occupational

therapist Orthotic technician Psychologist Physical therapist

Physician Rabbi Recreational

therapist Engineer Secretary Social worker Speech therapist

urologist, orthopedic, neurosurgeon, plastic surgeon, ID, ENT, medicine, pain,

psychiatrist………

Spinal cord injury rehabilitation unit

?

A Model

Inpatient rehab Outpatient rehab

Respiratory

Day care Clinics

Amb. therapies

CBRP

SCI program

Acute care

Living with SCILifetime follow-up Prevention:

Secondary impairment Secondary disability

Early intervention

Education Health promotion/wellness education

The 2 “RE’s”

Community re-entry program

Re-rehabilitation program

ד"ר גבי זייליג

המחלקה לשיקום נוירולוגי[email protected]

New rehabilitation tools

Methods/techniques of training

Medications

Devices

Home adjustment

AccessibilityAccessories

Equipment

Sports & physical activity

Memento Main causes of morbidity &

mortality: Infections Pressure sores Respiratory failure Cardio-vascular Suicide

The annual cost of treating pressure sores alone is estimated at $1.2 billion (Byrne and Salzberg 1996).

Hospital length of stay

Equipment Accessories Psych Housing Accessibility

Committee on Trauma. Resources for Optimal Care of the Injured Patient. American College of Surgeons, 1990.

“….It is illogical to develop sophisticated prehospital and hospital care to resuscitate and treat severely injured patients only to transfer them to custodial facilities after acute care without adequate rehabilitation…..The designation of rehabilitation facilities with the necessary staffing skills and programs to comprehensively serve people with spinal cord injury is as important as the need for specialized trauma services.